Impact of introducing electronic acute kidney injury alerts in primary care

Background Acute kidney injury (AKI) is associated with decreased survival, future risk of chronic kidney disease and longer hospital stays. Electronic alerts (e-alerts) for AKI have been introduced in the UK in order to facilitate earlier detection and improve management. The aim of this study was to establish if e-alerts in primary care were acted on by examining timing of repeat creatinine testing. Methods The National Health Service England Acute Kidney Injury electronic alert algorithm was introduced in April 2015 across both primary and secondary care in NHS Tayside accompanied by a programme of education. Data from a 12-month period (2012) predating introduction of the e-alerts were compared with a 12-month period following implementation of e-alerts for AKI. Biochemistry testing following the AKI episode, timing of repeat tests and numbers of patients hospitalized within 7days of episode were compared between the two time periods. Results During the 12months after e-alert introduction, 9781 AKI e-alerts were generated. Of these, 1460 (14.9%) alerts were generated in primary care. Median duration to repeat blood testing for these primary care alerts was 5days for AKI Stage 1 [interquartile range (IQR) 2-10], 2days for Stage 2 (IQR 1-5) and 1day (IQR 0-2) for Stage 3. During 2012 (prior to e-alert implementation) 8812 AKI episodes were identified. Of these, 2650 tests (30.1%) were requested by primary care staff. Median duration to repeat creatinine testing was longer: 55days (IQR 20-142) for Stage 1, 38days (IQR 15-128) for Stage 2 was and 53days (IQR 20-137) for Stage 3. More patients had biochemistry tests repeated within 7days of AKI onset, pre-alert implementation; 252 (9.5%) versus 857 (58.7%) (P<0.001). Rates of hospitalization within 7days of AKI increased from 342 (12.9%) pre-implementation to 372 (25.5%) post-implementation (P<0.001). Conclusions Within primary care, e-alert implementation was associated with higher rates of creatinine monitoring, but also higher rates of hospitalization.